AB0712 Digital Ischemic Complications in Systemic sclerosis associated Raynaud’s: Prevalence, Risk factors and Treatment patterns from a Single Center Cohort
Authors: A. Makol, A. Hinze, R. Giblon, Y. Radwan, T. Gunderson, D. Liedl, K. J. Warrington, C. S. Crowson, P. Wennberg
Journal: Annals of the Rheumatic Diseases (2022)

Background A significant number of Systemic sclerosis (SSc) patients with Raynaud’s phenomenon (RP) experience digital ischemic complications (DICs-digital ulcers, digital pitting/scars, gangrene and/or amputation). Objectives We reviewed the prevalence &amp; risk factors for DICs in SSc-RP and compared treatment patterns among patients with &amp; without DICs. Methods SSc patients meeting ACR/EULAR 2013 classification criteria that underwent an upper extremity arterial study between 2001-2018 were included. Clinical characteristics, treatment for RP, use of antiplatelet (aspirin 81 mg), statin therapy &amp; occurrence of DICs, digital occlusive arterial disease (DOAD) on laser doppler flowmetry (LDF) and macrovascular disease (MVD) on duplex US were abstracted. Risk factors for DICs and their associations with therapy were evaluated. Results We identified 273 SSc patients (mean age 57±13 y, 81% F, 93% Caucasian, mean disease duration 4.8 ± 7.1 y). Cohort characteristics are described in Table 1. 79% (217/273) patients experienced DICs (digital ulcers 203, digital pitting/scar 138, digital gangrene 76). Patients with DICs had a higher prevalence of DOAD (89% vs 54%, p &lt;0.001), MVD (32% vs 9%, p &lt;0.001), ILD (41% vs. 27%, p=0.04), calcinosis (95/192 (49%) vs. 7/44 (16%), p&lt;0.001), and pericardial effusion (25% vs. 12%, p=0.047), compared to those without DICs. No difference was noted between the 2 groups in regard to skin severity, smoking, BMI, hypertension, hyperlipidemia, diabetes, coronary artery disease, telangiectasias, pulmonary hypertension, renal crisis, GI dysmotility or myositis. Treatment patterns are described in Figure 1. Calcium channel blocker (CCB) and phosphodiesterase 5 inhibitor (PDE5I) use was higher among SSc patients with DICs than in those without DICs (CCBs: 53% vs. 34%, p=0.01; PDE5: 29% vs. 2%, p=0.01) likely due to confounding by indication. The use of aspirin or statins was not associated with DICs, even after adjusting for CV risk factors (ASA: OR 0.83, 95% CI 0.45-1.54; statin OR 0.67, 95% CI 0.28-1.62). Conclusion Our study confirms a high prevalence of DICs in SSc, with digital ulcers occurring in nearly 75% patients. A higher risk of DICs is associated with DOAD, MVD, ILD, calcinosis and pericardial effusion. While there is a significantly higher utilization of vasodilators among patients with DICs, the utilization of antiplatelet therapy and statins was not different among these groups. Whether this suggests a lack of evidence supporting their use in clinical practice, or inefficacy in preventing DICs remains unclear and warrants further study. Table 1. Overall (N=273 ) DICs (N=217 ) No DICs (N=56 ) p-value Demographics Age at procedure(y); mean (SD) 57.5 (13.3) 56.9 (13.6) 59.4 (11.8) 0.25 Sex (Female) 220 (81%) 173 (80%) 47 (84%) 0.48 Race (White) 253 (93%) 199 (92%) 54 (96%) 0.73 BMI (kg/m 2 ) at study; mean (SD) 26.6 (6.1) 26.3 (6.1) 27.4 (6.1) 0.14 Smoking status Never 154 (56%) 120 (55%) 34 (61%) 0.76 Former 102 (37%) 83 (38%) 19 (34%) Current 17 (6%) 14 (6%) 3 (5%) Disease characteristics SSc subtype: Limited 211 (77%) 166 (76%) 45 (80%) 0.18 Diffuse 59 (22%) 49 (23%) 10 (18%) Time from SSc diagnosis to duplex US (months) mean (SD) 57.9 (85.7) 63.5 (91.5) 36.1 (52.9) 0.04 Digital occlusive arterial disease 223 (82%) 193 (89%) 30 (54%) &lt;0.001 Macrovascular disease 74 (27%) 69 (32%) 5 (9%) &lt;0.001 Ulnar Occlusive disease 68 (25%) 63 (29%) 5 (9%) 0.002 Telangiectasias 239 (88%) 192 (89%) 47 (84%) 0.27 Calcinosis 102 (43%) 95 (49%) 7 (16%) &lt;0.001 Interstitial lung disease 105 (38%) 90 (41%) 15 (27%) 0.04 Pulmonary hypertension 50 (18%) 43 (20%) 7 (12%) 0.21 Pericardial effusion 61 (22%) 54 (25%) 7 (12%) 0.047 Gastrointestinal dysmotility 194 (71%) 159 (73%) 35 (62%) 0.11 Renal crisis 17 (6%) 12 (6%) 5 (9%) 0.35 SSc specific antibodies: 175 (68%) 138 (67%) 38 (69%) 0.77 Centromere 116 (63%) 95 (63%) 21 (64%) 0.97 Scl-70 48 (19%) 36 (18%) 12 (22%) 0.57 RNA-Polymerase 19 (20%) 14 (19%) 5 (22%) 0.79 Figure 1. Disclosure of Interests None declared